NCCN VERSION 2 2015

NCCN Guidelines Index

Breast Cancer Table of Contents

Discussion

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NCCN Guidelines Version 2.2015

Breast Cancer

ST-2

Staging

Staging continued on next page (ST-3)

Table 1 (continued)

Regional Lymph Nodes (N)

Clinical

Regional lymph nodes cannot be assessed (e.g., previously

removed)

No regional lymph node metastasis

Metastases to movable ipsilateral level I, II axillary lymph node(s)

Metastases in ipsilateral level I, II axillary lymph nodes that are

clinically fixed or matted; or in clinically detected* ipsilateral

internal mammary nodes in the

absence

of clinically evident

axillary lymph node metastases

N2a

Metastases in ipsilateral level I, II axillary lymph nodes fixed to

one another (matted) or to other structures

N2b

Metastases only in clinically detected* ipsilateral internal

mammary nodes and in the

absence

of clinically evident level I, II

axillary lymph node metastases

Metastases in ipsilateral infraclavicular (level III axillary) lymph

node(s) with or without level I, II axillary lymph node involvement;

or in clinically detected* ipsilateral internal mammary lymph

node(s) with clinically evident level I, II axillary lymph node

metastases; or metastases in ipsilateral supraclavicular lymph

node(s) with or without axillary or internal mammary lymph node

involvement

N3a

Metastasis in ipsilateral infraclavicular lymph node(s)

N3b

Metastasis in ipsilateral internal mammary lymph node(s) and

axillary lymph node(s)

N3c

Metastasis in ipsilateral supraclavicular lymph node(s)

*Note: Clinically detected

is defined as detected by imaging studies (excluding

lymphoscintigraphy) or by clinical examination and having characteristics highly

suspicious for malignancy or a presumed pathologic macrometastasis based on

fine needle aspiration.

Pathologic (pN)*

pNX

Regional lymph nodes cannot be assessed (e.g., previously

removed, or not removed for pathologic study)

pN0

No regional lymph node metastasis histologically

Note:

Isolated tumor cell clusters (ITC) are defined as small clusters of cells not

greater than 0.2 mm, or single tumor cells, or a cluster of fewer than 200 cells in

a single histologic cross-section. ITCs may be detected by routine histology or by

immunohistochemical (IHC) methods. Nodes containing only ITCs are excluded

from the total positive node count for purposes of N classification but should be

included in the total number of nodes evaluated.

pN0(i-)

No regional lymph node metastasis histologically, negative IHC

pN0(I+)

Malignant cells in regional lymph node(s) no greater than 0.2 mm

(detected by H&E or IHC including ITC)

pN0(mol-)

No regional lymph node metastases histologically, negative

molecular findings (RT-PCR)

pN0(mol+)

Positive molecular findings (RT-PCR),** but no regional lymph

node metastases detected by histology or IHC

* Classification is based on axillary lymph node dissection with or without sentinel

lymph node biopsy. Classification based solely on sentinel lymph node biopsy

without subsequent axillary lymph node dissection is designated (sn) for “sentinel

node,” for example, pN0(sn).

** RT-PCR: reverse transcriptase/polymerase chain reaction.